WASHINGTON – Maryland excels in some areas of health care, like breast cancer screening and in-home care, but lags in others, such as pneumonia treatment and the number of HIV-related deaths, according to a new study.
The National Healthcare Quality Report, released last week, is an annual checkup on the quality of health care across the country, first ordered by Congress in 2003.
Overall, the quality of Maryland’s health care falls between weak and average, according to the agency that publishes the report, the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.
Karen Migdail, a spokeswoman for the agency, said Maryland’s results are not unusual.
“Most states have mixed results, they don’t do well on everything or poorly on everything,” Migdail said. “That’s pretty clear.”
Health care experts and advocates said Maryland has a solid system, and blamed the weak areas on the state’s budget constraints and physician shortage.
“As society takes stumbles, health care takes stumbles,” said W. James Reiter, vice president for communications at the Maryland Hospital Association. “Overall, it’s a very good system.”
Reiter said Maryland’s unique “all-payer rate” system encourages quality care. No other state has an all-payer system, which was designed in the 1970s to keep hospital reimbursement rates equal and therefore avoid differences in the quality of care.
Besides high marks in breast cancer screening for women over 40, Maryland has a low rate of suicide deaths, and excels in proper care for heart attack patients. Maryland is also in the highest 25 percent of states for adult home health care patients whose ability to walk or move around has improved.
Ethan Moore, director of health policy for the Health Facilities Association of Maryland, said Maryland’s nursing homes provide “expert care,” but the expected population explosion of adults 65 and over in the next 20 years will make in-home care even more important.
“We don’t have the dollars or the capacity to take care of everyone in nursing homes,” Moore said. “We want to be able to provide people with the care they need as much as possible in their home and their community.”
Moore criticized the all-payer system as expensive and inadequate and said it needs updating in the area of Medicaid reimbursements.
Maryland falls below average in HIV-infection deaths per 100,000 people and in providing recommended pneumonia care.
William Honablew Jr., chief of policy and public information for Maryland’s Infectious Disease and Environmental Health Administration, acknowledged the HIV-death rate is high. However it has decreased — from nearly 1,600 in 1995 to fewer than 500 in 2006 — because of better medical treatment and earlier screening for high-risk patients, he said.
The lack of care for pneumonia patients might be because the state faces a major physician shortage, said Gene Ransom, CEO of the state’s medical society, MedChi. Pneumonia is usually treated by primary care physicians, who are in high demand, he said.
“When you have these shortages, it’s going to result in a weakening of the quality of care in some cases,” Ransom said. Still, he said, “Maryland has one of the best health care systems in the country.”
Other data from the Maryland Hospital Association show Maryland is about average in the nation for properly treating pneumonia patients, and the 2008 National Healthcare Quality Report said Maryland was average in giving pneumonia vaccinations to adults 65 and over.
In many other health care areas, the report showed Maryland on par with or slightly above the national average, including giving appropriate antibiotics to surgery patients and using physical restraints for nursing home residents.
Maryland is even with or slightly below the national average in providing coordinated care for children with special needs, and registering dialysis patients on a waiting list for kidney transplants.
Susan O’Brien, vice president of public affairs for the Health Facilities Association of Maryland, said the physical restraint data are encouraging, because the report showed a 52 percent national decline over the past 10 years. She also said Maryland’s nursing homes excel in providing breast cancer screening for residents.
However, she also said the state has reached “a tipping point for resources” for the elderly population.
Maryland’s rankings in the 2009 report are about the same as in 2008.
The national health care agency also uses the same data to create state profiles, which show that Maryland is behind neighbors Virginia, Delaware, New Jersey and Pennsylvania, and is below average nationally. The profiles also show Maryland’s health care quality declined from 2006 to 2008.
Additionally, Maryland’s profile shows there is a serious gap in the quality of health care that high-income ($61,000 and above) and low-income ($36,999 and below) residents receive, compared to the national average. The gap in the disparity of quality of care for Whites and Blacks is small, and there is virtually no gap between quality of care for Hispanics and Whites.
Anne S. Kasper, chairwoman of Maryland Women’s Coalition for Health Care Reform, said there is a lot of room for improvement even though Maryland is one of the wealthiest states.
“We have some real critical problems,” Kasper said, including budget cuts of nearly 50 percent for local health departments in the past year, as well as reduced funding for programs like substance abuse prevention for teens.
Budget, staff cuts and outdated technology are major issues, she said, that Maryland must address to meet future federal health reform requirements.
“It’s not just a matter of filling holes and waiting for the dollars to come,” said Kasper. “We really need more of a vision.”